CSN:Landry elects not to have surgery

[The Batman]

Guys, let's reserve judgment on Landry unless you are familiar with the treatment modalities behind the injury, which most of you are not. Achilles' tendon replacements have a long and grueling rehabilitation, often lead to long term movement impairment, and are unquestionably structurally weaker and more prone to complete rupture later. Landry, unless my understanding is incorrect, has an injury consisting of a series of microtears in the tendon. Regardless of anyone on this board's gut reaction to "LANDRY DOESN'T WANT TO HAVE SURGERY", if that is truly the nature of his condition, he is making the right decision. A microtear condition responds much more effectively to conservative modalities such as rapid eccentric loading of the gastrocsoleus complex than a complete surgery, which is unnecessary in that case and avoided by competent orthopaedists even in the case of a partial tear. These conservative interventions have much better long-term outcomes for his ability to be the athlete he needs to be and he is simply trying to make the best decision for the health of his tendon, as surgery is typically only necessary and recommended in the case of a complete rupture. The same goes for Mike Shanahan - just because he has extensive experience as a head coach does NOT make him qualified to know whether or not Landry needs surgery. I would recommend a degree of reservation before we fly off the handle and look like a gaggle of idiots deriding Landry for making a decision that is supported in the literature with regard to the health of his tendon. Besides, does it really make sense that Landry would SABOTAGE HIS OWN REHABILITATION?

Come on, people.

[S.T.real,lights,out]

Guys, let's reserve judgment on Landry unless you are familiar with the treatment modalities behind the injury, which most of you are not. Achilles' tendon replacements have a long and grueling rehabilitation, often lead to long term movement impairment, and are unquestionably structurally weaker and more prone to complete rupture later. Landry, unless my understanding is incorrect, has an injury consisting of a series of microtears in the tendon. Regardless of anyone on this board's gut reaction to "LANDRY DOESN'T WANT TO HAVE SURGERY", if that is truly the nature of his condition, he is making the right decision. A microtear condition responds much more effectively to conservative modalities such as rapid eccentric loading of the gastrocsoleus complex than a complete surgery, which is unnecessary in that case and avoided by competent orthopaedists even in the case of a partial tear. These conservative interventions have much better long-term outcomes for his ability to be the athlete he needs to be and he is simply trying to make the best decision for the health of his tendon, as surgery is typically only necessary and recommended in the case of a complete rupture. The same goes for Mike Shanahan - just because he has extensive experience as a head coach does NOT make him qualified to know whether or not Landry needs surgery. I would recommend a degree of reservation before we fly off the handle and look like a gaggle of idiots deriding Landry for making a decision that is supported in the literature with regard to the health of his tendon. Besides, does it really make sense that Landry would SABOTAGE HIS OWN REHABILITATION?

Come on, people.

Damn are you a Doctor??? Or did you look that up on WebMD???

I agree if not having surgery is the right thing to do well obviously someone is trying to make a story out of nothing. And no it doesn't make sense that he would sabotage his own rehab....but do i think he would take the quick way out just to get back on the field and be able to get paid next season?? :yes:

Wasn't it just this season that he was bashing the training staff that they didn't know what they were doing and that he was ready to play? Which from how he played and how many games he played was clearly not the case..

[MartinC]

I can understand Landrys decision to a certain extent - the surgery is not guaranteed to work (though it has pretty good odds) and even if it does there is no guarantee he comes back at 100%. It's a gamble with his career and at this stage would probably mean he will miss some time in 2012 whatever the outcome.

On the other hand its hard to see how this chronic condition is going to go away absent a miracle or surgery. Rest and non surgical procedures have not worked so far and what's going to change there?

I don't think we can waste the franchise tag on him or the cap space that would need when its almost certain he will be a part time player next year one way or another. It's difficult to see him getting big offers from other teams either for the same reason.

I think his refusal to have early surgery has painted him into a corner and it's not easy to see a way out for him unless he will take a 'prove I type deal' with a low signing bonus and 1st year salary and incentive clauses and a team option at the end of the first year with much larger guaranteed money and base salary. Essentially give him 1 year to get healthy and prove he can stay on the field.

Bottom line I'd move on - we can't rely on his availability and need to plan on the assumption he will not be a Redskin next year.

[DexterSackMachine]

Despite the man crushes on ES, Landry has turned out to be a way bigger top 10 draft pick bust than Rodgers. Putting the franchise tag on someone who has a chronic Achilles injury that has completely limited him the past season and a half would be insane.

Amen Brother! The few left who still defend Laron should take off the blinders. The 6th pick in the draft has missed 16 games in 5 seasons, has 4 career interceptions, 5 fumble recoveries, and 290 career tackles. He also has sat out almost every training camp and has missed more tackles than I care to remember. In addition to this, his me first attitude seemed to rub off on Atogwe this season. Why in the world anyone would want to keep him on anything other than a bargain basement deal is beyond me. He does more harm than good each year at this point. And to think, we could have taken Peterson or Revis with that pick...

[justice98]

I think he should get the surgery because he's tried the non-surgical approach and it cost him, but I'm not doctor. There's more than one way to skin a cat. Maybe he should go to Europe and get in on some of those treatments that have athletes nowadays going over there.

But it's hard for me to rip a guy for not wanting to have surgery and get cut on. If it were my achilles, I wouldn't want surgery if I could help it either.

[MartinC]

Guys, let's reserve judgment on Landry unless you are familiar with the treatment modalities behind the injury, which most of you are not. Achilles' tendon replacements have a long and grueling rehabilitation, often lead to long term movement impairment, and are unquestionably structurally weaker and more prone to complete rupture later. Landry, unless my understanding is incorrect, has an injury consisting of a series of microtears in the tendon. Regardless of anyone on this board's gut reaction to "LANDRY DOESN'T WANT TO HAVE SURGERY", if that is truly the nature of his condition, he is making the right decision. A microtear condition responds much more effectively to conservative modalities such as rapid eccentric loading of the gastrocsoleus complex than a complete surgery, which is unnecessary in that case and avoided by competent orthopaedists even in the case of a partial tear. These conservative interventions have much better long-term outcomes for his ability to be the athlete he needs to be and he is simply trying to make the best decision for the health of his tendon, as surgery is typically only necessary and recommended in the case of a complete rupture. The same goes for Mike Shanahan - just because he has extensive experience as a head coach does NOT make him qualified to know whether or not Landry needs surgery. I would recommend a degree of reservation before we fly off the handle and look like a gaggle of idiots deriding Landry for making a decision that is supported in the literature with regard to the health of his tendon. Besides, does it really make sense that Landry would SABOTAGE HIS OWN REHABILITATION?

Come on, people.

Good points but they have been trying the non surgical route for a couple of years now and it's not responding. He has had a couple of specialists look at the injury and reports are they are recommending surgery now.

I do understand Landrys reluctance to go that route as it could end his career, but given what the whole NFL has seen from him the last couple of years without surgery I don't think he has much chance of a big contract without successful surgery.

[S.T.real,lights,out]

This is from breaking news section.....just about the same article but i think it's from the WT...if the doctor recommended that he has the surgery well IMO he should of had it.

"Dr. Robert Anderson, a renowned foot and ankle specialist, recommended last month that Landry have surgery. However, Landry is not following that course — at least not yet."

[SkinFaninOKC]

Guys, let's reserve judgment on Landry unless you are familiar with the treatment modalities behind the injury, which most of you are not. Achilles' tendon replacements have a long and grueling rehabilitation, often lead to long term movement impairment, and are unquestionably structurally weaker and more prone to complete rupture later. Landry, unless my understanding is incorrect, has an injury consisting of a series of microtears in the tendon. Regardless of anyone on this board's gut reaction to "LANDRY DOESN'T WANT TO HAVE SURGERY", if that is truly the nature of his condition, he is making the right decision. A microtear condition responds much more effectively to conservative modalities such as rapid eccentric loading of the gastrocsoleus complex than a complete surgery, which is unnecessary in that case and avoided by competent orthopaedists even in the case of a partial tear. These conservative interventions have much better long-term outcomes for his ability to be the athlete he needs to be and he is simply trying to make the best decision for the health of his tendon, as surgery is typically only necessary and recommended in the case of a complete rupture. The same goes for Mike Shanahan - just because he has extensive experience as a head coach does NOT make him qualified to know whether or not Landry needs surgery. I would recommend a degree of reservation before we fly off the handle and look like a gaggle of idiots deriding Landry for making a decision that is supported in the literature with regard to the health of his tendon. Besides, does it really make sense that Landry would SABOTAGE HIS OWN REHABILITATION?

Come on, people.

Did you sleep at a Hoilday Inn Express?? I don't think he would sabotage his rehab either since he does want a big contract.

[GaryGreenMonk]

Honestly, I think Landry is milking his ability to get paid. I'd do the same thing.

The alternative treatments have little chance of actually working, but they COULD work. So that leaves him up in the air as he could get better. Putting us in the position we are in, even though it's unlikely he heals with these treatments.

The surgery has a 50/50 chance of working and could leave him with a permanently weak ankle and he may never regain his burst after surgery. So surgery could basically end his career if it doesn't rehab well.

My guess is this coming season is the last year he can milk on alternative treatments because we will release him (if we even keep him this year).. so he'll probably opt to go ahead and have the surgery after that or if we decide to release him before this coming season starts.

The sucky part of it all.. is he's not going to opt for the surgery until we have released him.

[Gibbs Hog Heaven]

To think that we could be on the verge of straight out cutting a 27 year old 6th overall pick, who should be in his prime and well on the way to securing a HoF gig; but who instead, through his lax professional attitude to be kind to both his craft and team, and his utter selfishness over refusing to take medical advice; is sickening.

How anyone continues to defend him is beyond me.

Hail.

[SWFLSkins]

If he pulls a Carlos Rogers, and gets the surgery after we don't resign him and he's on another team, my head is going to explode.

Please use a bag.

---------- Post added January-24th-2012 at 09:17 AM ----------

This is from breaking news section.....just about the same article but i think it's from the WT...if the doctor recommended that he has the surgery well IMO he should of had it.

"Dr. Robert Anderson, a renowned foot and ankle specialist, recommended last month that Landry have surgery. However, Landry is not following that course — at least not yet."

This should verify the need for surgery that some are explaining away. This injury has lingered further suggesting that rehab has no repaired the micro tears.

[hp703]

There could be another hand in play but, this reads future injury all over it

[da#1skinsfan]

Guys, let's reserve judgment on Landry unless you are familiar with the treatment modalities behind the injury, which most of you are not. Achilles' tendon replacements have a long and grueling rehabilitation, often lead to long term movement impairment, and are unquestionably structurally weaker and more prone to complete rupture later. Landry, unless my understanding is incorrect, has an injury consisting of a series of microtears in the tendon. Regardless of anyone on this board's gut reaction to "LANDRY DOESN'T WANT TO HAVE SURGERY", if that is truly the nature of his condition, he is making the right decision. A microtear condition responds much more effectively to conservative modalities such as rapid eccentric loading of the gastrocsoleus complex than a complete surgery, which is unnecessary in that case and avoided by competent orthopaedists even in the case of a partial tear. These conservative interventions have much better long-term outcomes for his ability to be the athlete he needs to be and he is simply trying to make the best decision for the health of his tendon, as surgery is typically only necessary and recommended in the case of a complete rupture. The same goes for Mike Shanahan - just because he has extensive experience as a head coach does NOT make him qualified to know whether or not Landry needs surgery. I would recommend a degree of reservation before we fly off the handle and look like a gaggle of idiots deriding Landry for making a decision that is supported in the literature with regard to the health of his tendon. Besides, does it really make sense that Landry would SABOTAGE HIS OWN REHABILITATION?

Come on, people.

Very interesting post, what are your qualifications? Im not saying that to be a smart-ass Im genuinely asking.

Only thing I have to go on is that the guy missed half of the 2010 season, and all of the offseason, and the first 2 games of this season...that's almost a full year off the field. He plays a bit and again gets hurt. So clearly, if a year of rest didnt heal him, what are we going to do, give him 2 years of rest?

That, combined with the blurb about the doctor who recommended he get surgery, tells me something here is wrong. Unless there are some alternative treatments or something else going on that Landry feels gives him a shot at full recovery, I dont see how "resting" is still a viable option.

[jflow78]

Guys, let's reserve judgment on Landry unless you are familiar with the treatment modalities behind the injury, which most of you are not......Come on, people.

Here's the issue, he's not getting surgery from some guy that just got out of his residency program. He's getting surgery from the best in the field. So, because those stats are a compilation of thousands of doctors over 10s of years (and since the field has advanced significantly since they began doing the operation) the chance of him getting better is much higher than the ones you've found.

The team invested millions in the guy this season, they aren't going to sabotage his career, they want him to get better. And, Landry is not getting a complete Achilles repair, so the operation won't be THAT invasive in the first place.

Yes, it's not 100% guaranteed, neither is ANY recovery from an achilles injury, but so far the "alternative" treatment he opted for last year was 0% successful. There are a million alternative therapies he can try, but how long is he willing to wait until he does what needs to be done?

EDIT:

WebMD has the stat at 80% success rate and a 5% reinjury rate, and that's not using the best doctors in the field as an example, so I'd like to know what their success rate is with a guy that's getting rehab and PT attention daily. Those stats likely come from athletes in high school and college who are given lots of work to do at home on their own, not professional athletes with millions invested into them.

[Gibbs Hog Heaven]

Even on a complete repair, the odds on previous athletes having the surgery and coming back to full health to continue their careers, particularly in soccer, are around 70% jflow man. There's a risk with any surgery, but the risk on this ways far more in Landrys favor than not as some have suggested.

Hail.

[The Batman]

Did you sleep at a Hoilday Inn Express?? I don't think he would sabotage his rehab either since he does want a big contract.

No, I'm sleeping at a hellish Hotel California called physical therapy school.

---------- Post added January-24th-2012 at 09:45 AM ----------

Here's the issue, he's not getting surgery from some guy that just got out of his residency program. He's getting surgery from the best in the field. So, because those stats are a compilation of thousands of doctors over 10s of years (and since the field has advanced significantly since they began doing the operation) the chance of him getting better is much higher than the ones you've found.

The team invested millions in the guy this season, they aren't going to sabotage his career, they want him to get better. And, Landry is not getting a complete Achilles repair, so the operation won't be THAT invasive in the first place.

Yes, it's not 100% guaranteed, neither is ANY recovery from an achilles injury, but so far the "alternative" treatment he opted for last year was 0% successful. There are a million alternative therapies he can try, but how long is he willing to wait until he does what needs to be done?

EDIT:

WebMD has the stat at 80% success rate and a 5% reinjury rate, and that's not using the best doctors in the field as an example, so I'd like to know what their success rate is with a guy that's getting rehab and PT attention daily. Those stats likely come from athletes in high school and college who are given lots of work to do at home on their own, not professional athletes with millions invested into them.

What I'm pulling my information from has nothing to do with the changes in the surgery over time and the advances in the field, nor the skill of the surgeon. What I am referring to is the fact that an Achilles' transfer is a reduction surgery in which the tendon is INHERENTLY WEAKER. I am basing my analysis predominantly on the tissue histology behind tendon repair and what it means with regard to the strength of the tendon. If I cut a piece of paper in half and threw the other half away, and told a kindergartner to do the same thing, we'd still both have half a sheet of paper, despite the fact that I'd have a much neater cut. That's what I'm referring to. He will have less tendon. If it is determined that an aggressive approach to non-surgical interventions is continuing to not work, then he has a tendinosis that is simply not fixable. That is a rare condition in the scheme of things. These interventions are designed to initiate an inflammatory response, transforming his tendinosis into tendinitis, which is desirable, as inflammation is a healing response. If they can initiate inflammation, his tendon IS HEALING. He is obviously trying all his options before he permanently weakens the tendon for the rest of his life, and I for one don't blame him for that.

[justice98]

This is from breaking news section.....just about the same article but i think it's from the WT...if the doctor recommended that he has the surgery well IMO he should of had it.

"Dr. Robert Anderson, a renowned foot and ankle specialist, recommended last month that Landry have surgery. However, Landry is not following that course — at least not yet."

Maybe if there was only one doctor giving his opinion. I mean, how many opinions did he get? Isn't the smart thing to do to always get multiple opinions? Perhaps there was no consensus.

[jflow78]

No, I'm sleeping at a hellish Hotel California called physical therapy school.

---------- Post added January-24th-2012 at 09:45 AM ----------

What I'm pulling my information from has nothing to do with the changes in the surgery over time and the advances in the field, nor the skill of the surgeon. What I am referring to is the fact that an Achilles' transfer is a reduction surgery in which the tendon is INHERENTLY WEAKER. I am basing my analysis predominantly on the tissue histology behind tendon repair and what it means with regard to the strength of the tendon. If I cut a piece of paper in half and threw the other half away, and told a kindergartner to do the same thing, we'd still both have half a sheet of paper, despite the fact that I'd have a much neater cut. That's what I'm referring to. He will have less tendon. If it is determined that an aggressive approach to non-surgical interventions is continuing to not work, then he has a tendinosis that is simply not fixable. That is a rare condition in the scheme of things. These interventions are designed to initiate an inflammatory response, transforming his tendinosis into tendinitis, which is desirable, as inflammation is a healing response. If they can initiate inflammation, his tendon IS HEALING. He is obviously trying all his options before he permanently weakens the tendon for the rest of his life, and I for one don't blame him for that.

That's awesome, I'm in a medical program as well. Regardless of whether the procedure is the same, you must realize, especially having the background that you do, that the experience of the doctor doing the surgery has a profound effect on whether the surgery is successful in the long term, as does the quality of therapy the patient gets. I understand the histology, but scar tissue that forms around the injury decreases the tissue's ability to sustain any type of kinetic strain increasing the likelihood of tearing as well. My point is, once you've injured the tissue, the likelihood of rein jury is always going to be higher regardless of what option you take for recovery. His tissue has already begun separating, so it's' not as if we're working with a healthy tendon in the first place.

The truth is, regardless of how much school either of us has, the discussion on these procedures is NOT 100% agreed upon. So, I'm fairly sure anyone can take any position they want in this argument and be validated with studies and evidence that point out that one side or the other is more correct. That's medicine for you.

EDIT:

Also, I'm curious as to what therapy you're specifically referring to, since tendonosis is a degeneration while tendinitis is an inflammatory, or overuse, condition. If he has tendonitis, how much rest is enough, since last year (while on IR and then an extended offseason) he had plenty of time to rest the injury. Apparently the experts, of which none of us on this forum are, have decided it's time for surgery. I don't think Laron is a bad guy, I think it's more likely that he's an athlete who's nervous about going under the knife. I don't blame him, but after trying "alternative" therapy for the last year, he's wasting his career waiting for miraculous results. He's got a VERY good chance of having a successful surgery and recovery after surgery, especially with the surgeons he's going to have working on him. Dr Andrews is no slouch.

[S.T.real,lights,out]

Maybe if there was only one doctor giving his opinion. I mean, how many opinions did he get? Isn't the smart thing to do to always get multiple opinions? Perhaps there was no consensus.

You def could be right....i know this doctor is one of the best doctors in the US...and someone else may have said he shouldn't do it..:whoknows:

[Slateman]

So Laron thinks that if he does the same thing as this past season, he'll have different results?

[Critz1407]

I think you have to keep him on a one year deal this year. If we are looking to move up in the draft then we can not afford a draft pick at safety this year( At least not for star safety) He is still the best option we have. I don't see anyone better in FA this year.

Sure draft some one for depth and if he doesn't work out this year then we know we can draft someone next year. With all our holes on offense and missing a dominant corner. I don't see how we draft a safety that is a starter day one.

If hes healthy great we have a play maker, if not well then its either Reed, Gnomes, or a late draft pick. Basically the same thing as if we did cut him. I just dont see anyone better in FA unless we cut Reed even then. I would sign Landry for the year and see where it goes.

[jflow78]

http://www.washingtonpost.com/blogs/football-insider/post/laron-landrys-future-hinges-on-alternative-medicine-procedure/2012/01/24/gIQAhMqXNQ_blog.html

"Landry met in December with Dr. Robert Anderson, one of the country’s top foot and ankle specialists, and was told that he would need surgery on the injured Achilles’ tendon, which has limited him to 17 games over the last two seasons. Anderson believed that barbs on the bone in the area need to be shaved down so the tendon wouldn’t continue to be snagged when the player tried to run, Landry said."

That's most recent update.

So the doctor believes the issue is the bone growth (probably due to the initial injury) under the tendon that's causing the injury to recur. So, at this point, I'm not sure we're even talking about a normal achilles surgery. This sounds more like a bone spur removal which, if he opts for alternative medical procedures, would be exactly the opposite of the type of non-surgical care used on tendinosis and more in line with those of tendinitis. If he went through alternative care for tendinitis last year, then there's no way continuing the same care he received for at least 6 months will change the outcome much, at this point. We'll see how this all goes.

[KDawg]

Okay, so, even if surgery isn't the best option...

If Landry does rehab, he did the same thing last offseason... And he wasn't ready right off the bat, and his season ended early. So, it's doubtful he'd be ready at the beginning of this upcoming season... (This is a pure guess, anyone with real medical knowledge feel free to tell me I'm a schmuck). So we're going to pay this guy a lot of money and he may not be ready to play until late in the season if at all?

[jflow78]

Okay, so, even if surgery isn't the best option...

If Landry does rehab, he did the same thing last offseason... And he wasn't ready right off the bat, and his season ended early. So, it's doubtful he'd be ready at the beginning of this upcoming season... (This is a pure guess, anyone with real medical knowledge feel free to tell me I'm a schmuck). So we're going to pay this guy a lot of money and he may not be ready to play until late in the season if at all?

As far as I'm aware, there's no "alternative" procedure or rehab that should take longer than the period of time he had last offseason, and be more successful this year than it was last year. Obviously the opinion may differ, a surgeon will tell you to have surgery, a PT will tell you to exercise it, an MD will give you a cortisone shot, so there's not going to be ONE opinion that will definitively give a 100% answer.

My guess though is that he tried alternative therapy last year from the time he went on IR (14 Dec 2010) to the time he had practice again (lets say the end of July 2011 at TC), then I can't imagine more time is going to change anything. If the doctor he most recently saw is correct, and his issue is compounded, or lingering, due to bone growth in response to his injury, then no amount of alternative therapy is going to fix it.

EDIT:

The rest of the WP article says last year he had Platelet Rich Plasma injections (same ones they used on Banks' knee) and this year he's trying something different, and won't know the outcome until March. I'd be interested to find out what that is, but they haven't said yet. PRP injections are the newest non-surgical therapy that I'm aware of for injuries of this nature, so I'm not sure what he's doing now. But, like I said before, if the injury really is complicated or being aggravated by bone growth, then there's not much they can do, that I know of.

Someone else may have more info, since I'm not in practice yet.

[Coach Janky Spanky]

Very disappointing he's not had surgery yet -- the season's been over for almost a month now. Hopefully he changes his mind.

I still think we take a chance on him and re-sign him, whether to an incentive laden one-year gig or franchising him. I just think we've let too many home grown guys walk in the past and it's ended up biting us in the rear. Antonio Pierce, Ryan Clark...heck even Carlos Rogers, although he wanted to go anyways. I think even though there's risk and even though Landry really hasn't been himself for almost 2 years now, he's worth taking that chance. We've always done the opposite, and the opposite has never worked.